Provider Demographics
NPI:1215297213
Name:RANSOM, ERNIE GENO (CDP)
Entity type:Individual
Prefix:
First Name:ERNIE
Middle Name:GENO
Last Name:RANSOM
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 S TACOMA WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4595
Mailing Address - Country:US
Mailing Address - Phone:253-302-3826
Mailing Address - Fax:253-267-5212
Practice Address - Street 1:8811 S TACOMA WAY STE 106
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4595
Practice Address - Country:US
Practice Address - Phone:253-302-3826
Practice Address - Fax:253-267-5212
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60566667101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)